The Impact of
on Cancer Care and Research
Gunnar Saeter MD, Ph.D
Chair, OECI Accreditation Committee Professor and Head of Research
Division of Cancer Medicine Oslo University Hospital
Comprehensive Cancer Centres Comprehensiveness
Disclosure:
2009-2013
Basic, Translational
& Clinical Research
University affiliation
Epidemiology Cancer Prevention
High Quality Clinical Care
Comprehensiveness
CCC
Programs:
USA (NCI) Europe (OECI)
Germany
Traditional Paradigm for Cancer Research
Basic Translastional Clinical Outcomes Research
Present and Future Paradigm:
Innovation
Background
• Unacceptable variation in quality of cancer care between institutions
• Increasing complexity and multidisciplinarity
• Need for integration of clinical care and research
• Consensus on treatment guidelines, but
• Lack of harmonization of actual clinical practice
• Lack of consensus on quality indicators
• Inadequate monitoring of quality
”Cancer Centre” concept:
• Structure, resources & organisation
• Clinical practice
• Strategy and coordination
• Quality system
• Volume, quality & integration of research
Accreditation & Designation Program
Tentative Pros
• Qualified external review of entire cancer activity
• Improvement plan to aid quality and development
• Resolution of internal disagreements
• Engagement and team building effect
• Resolve organisational issues in large hospitals
• International recognition
• Future external funding effects
Institutional Accreditation & Designation Program
Tentative Cons
• Amount of work & money
• Risk of loss of image & standing
• Criticism of individual elements
• Cancer vs. other areas of care
• Imposes unnecessary change
• ”What’s the real value?...
• 61 Full Member Institutions
• 19 Associate Member Institutions
Karolinska, Skåne
Vejle, Kræftens Bekæmpelse Helsinki, Turku, Tampere
Oslo
Currently 35 Cancer Centres in the A & D Program
Accreditation Process
• Self assessment by the Centre
• On-site audit
• Comparison of external and self assessments
• Conclusion: strengths and recommendations
• Improvement Plan mutually agreed
• Designation decision
• Takes approx. 6 months from submission of self assessment
7
Domains of the Accreditation Program
• 65 Qualitative standards and 38 Quantitative topics, 2-10 questions per item
• Supplemented by written documentation
• CC organisation, governance, resources, infrastructure, University affiliation
• Volume and specialization of CC staff, clinical care and research
• Planning and organisation of integrated care and research
• MDT structure, working model and Clinical Pathways
• Research volume, integration and translation into care
• Cancer Prevention programs
• Internal education programs
• Patient satisfaction and involvement
• Quality system and degree of constant quality improvement
8
OECI Designation Criteria 2016 Clinical Cancer Centre
(ClCC) Comprehensive
Cancer Centre (CCC) Organisation & governance. Treatment
modalities covered. Multidisciplinarity, quality, clinical pathways, education, research
organization & integration etc.
Qualitative
assessment Qualitative
assessment
Budget for oncology health care >25 M € >50 M €
Budget for oncology research >8 M €
Number of beds & ambulatory day care beds >100 >150
FTE physicians dedicated to cancer >30 >50
New cancer patients per year >1500 >2500
RESEARCH: Adequate for ClCC as assessed by the audit
team
Fulfill at least 3 of the following criteria:
Peer-reviewed scientific publications/year >125
Scientific publications with IF >10 >17
Scientific publications with IF 5 – 10 >50
Active clinical trials >75
Percentage of new patients included in
prospective clinical trials >10%
OECI Comprehensive Cancer Centres (N=14)
• Insitut Jules Bordet Brussels Belgium
• HYKS Helsinki Finland
• Institut Gustave Roussy Paris France
• CRO Aviano Italy
• IST Genova Italy
• IEO Milano Italy
• INT Milano Italy
• INT Regina Elena Roma Italy
• National Institute of Oncology Hungary
• IPO Porto Portugal
• Netherlands Cancer Institute Netherlands
• The Christie NHS Trust Manchester UK
• Cambridge Cancer Centre UK
• King’s Health Partners London UK
OECI Clinical Cancer Centres (N=11)
• Kankercentrum Brussel Belgium
• Vejle Sygehus Denmark
• Ülikooli Klinikum, Tartu Estonia
• Giovanni Paolo II Bari Italy
• INT Pascali Napoli Italy
• CROB Rionere in Vulture Italy
• S Maria Nuova Reggio Emilia Italy
• National Cancer Institute Vilnius Lithuania
• IPO Lisboa Portugal
• IPO Coïmbra Portugal
• IVO Valencia Spain
Cancer Centres currently under evaluation (N=10)
• AZ Groeninge Kortrijk Belgium
• Masarykuv onkologicky ustav Brno Czech republic
• Istituto Clinico Humanitas Milan Italy
• Centre Léon Bérard Lyon France
• Orszagos Onkologiai Intezet Budapest Hungary
• Oslo Universitetssykehus Oslo Norway
• Institute of Olncology Cluj Napoca Romania
• Anadolu Medical Centre Istanbul Turkey
• Tampere University Hospital Finland
• Trinity College Dublin Ireland
Comprehensive Cancer Centre of Excellence
(Translational research & Innovation) - Pilot program
Comprehensive Cancer Centre (CCC) Clinical Cancer Centre (ClCC)
Cancer Centre
Oslo University Hospital: ”Opportunities”
• Organisation of Cancer Centre
• Implement Cancer Centre Board across all relevant departments & divisions
o Mandate
o Representation o Governance
• Develop Institutional 3-5 year Cancer Strategy with Action Plan
• Further development & standardization of MDT´s & Clinical Pathways
• Biobanks and patient registers: centralisation and governance
• Increase accrual to clinical trials
• Etc.
Dept of Oncology (incl. Breast
surgery Stein Kaasa
Dept of Medical Physics Jan Rødal
Dept of Gastro- Intestinal
Surgery
Dept of Urology Øyvind Modalsli Dept of
Trans- plantation
Medicine Pål Dag Line
Dept of Rheuma- tology, Skin
& Infectious Diseases Jorun H.
Rønsen Dept of
Haema- tology
Geir Tjønnfjord
Dept of Clinical Services
Torhild Birkeland
Research Institute Internalfor Medicine Pål Aukrust Institute
Cancerfor Genetics Informaticsand
Håvard Danielsen Institute
Cancer for Research
(Gunnar Sæter) Dept of
Gynaecologic Oncology
RokkonesErik
Division of Surgery,Transplantation
& Inflammation
Morten Tandberg Eriksen
Division of Cancer Medicine, Surgery & Transplantation
Oslo University Hospital
9→15 Divisions from Jan 1, 2016 Division of Cancer Medicine
Sigbjørn Smeland
Pros
• External expert input adds power
• Helps resolve organisational and strategic issues
• Improves reporting structure and quality focus
• Identified shortcomings re. key documentation
• Improved integration of research
• Enthusiasm and team building effect
• International recognition ?
• Future funding effects ?
Accreditation & Designation Program
Cons?
• Plenty of work
• Costs money
• Risk of loss of image & standing
• Internal criticism
• Imposes unnecessary change
• Cancer vs. ”The Rest” internally
• ”What’s the real value?...
√
Do not underestimate!
- Numbers - Documents - Translations
The Oslo Experience…
Full Publications
OUH Division of Cancer Medicine
IF >10: 38 38 56
What about (C)CC networks?
• Self-acclaimed or official
• Loose compensatory or defined purpose
• Structure, leadership and roles
• Local/regional
• National
• International
• Quality assurance?
?
Initial OECI standpoints on
Comprehensive Cancer Networks (CCN)
• A CCN must fulfill at least all the requirements of a single CCC
• A CCC can not be built and established only through a network
• A CCN should be developed around an OECI recognized CCC
• The core institution in a CCN has the leadership for the integrated care, research and education in the network
• CCNs should be based on written/legal agreements between the partners of the network (coordination, division of tasks and responsibilities between partners)
• OECI accreditation of CCNs requires the development of specific network standards by OECI
• Promotes development of complete Clinical Pathways
Cancer Research
Institute Cancer
Research Institute
Cancer unit General
Hospital
Cancer unit General
Hospital Cancer unit
General Hospital Cancer unit
General Hospital
